HIV/AIDS

Human Immunodeficiency Virus (HIV) Overview

  • Definition: HIV is a retrovirus transmitted through blood and body fluids.
  • Sources of Transmission: Primarily through blood, vaginal fluids, breast milk. Less common in urine, feces, saliva, tears, cerebrospinal fluid.
  • Target Cells: Specifically attacks CD4+ T lymphocytes, integral to immune function.

Stages of HIV Progression

  • Stage 1: Primary HIV-1 Infection

    • Occurs 2 to 4 weeks post-infection.
    • Symptoms resemble flu: fever, fatigue, chills.
    • Increased viral load with a decrease in CD4+ cells.
    • Persistent lymphadenopathy during all stages.
    • CD4+ count: >500 cells/mm³.

  • Stage 2: Chronic Asymptomatic Infection

    • Can last over 10 years.
    • Anti-HIV antibodies present.
    • Increased viral loads indicating active replication and degradation of CD4+ cells.
    • CD4+ count: 200 to 499 cells/mm³.

  • Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

    • Characterized by severe immune system compromise.
    • Life-threatening opportunistic infections occur.
    • Without treatment, mortality within 3-5 years.
    • CD4+ count: <200 cells/mm³.

Risk Factors for HIV

  • High-Risk Activities:
    • Unprotected sex, multiple partners, occupational exposure.
    • Perinatal exposure, blood transfusions (rare in the U.S.), IV drug use with contaminated needles.

Diagnostic Indicators

  • Testing Methods:
    • Antibody assays become positive within 3 weeks to 3 months post-infection.
    • Common tests include Enzyme-linked immunosorbent assay (ELISA) and Western blot (confirmatory).
  • CD4+ Count Indicator:
    • Normal: 750 cells/mm³.
    • Risk of AIDS if <200 cells/mm³.

CDC and WHO Staging for HIV Disease

  • CDC Classification:
    • Stage 1: No AIDS-related conditions, CD4+ count ≥ 500.
    • Stage 2: No AIDS-related conditions, CD4+ count 200–499.
    • Stage 3: AIDS with CD4+ < 200 or presence of AIDS conditions.
  • WHO Classification:
    • Stages range from HIV infection to advanced HIV disease, based on CD4+ counts.

Clinical Manifestations of HIV/AIDS

  • General Symptoms:

    • Chills, fever, night sweats, fatigue, weight loss, lymphadenopathy, headache.

  • AIDS-Specific Symptoms:

    • Immunologic: Low CD4 counts (<200/mm³) leading to infections.
    • Integumentary: Poor wound healing, skin lesions.
    • Gastrointestinal: Diarrhea, nausea/vomiting, weight loss.
    • Neurological: Cognitive and motor impairments, including confusion and seizures.

  • Opportunistic Infections:

    • Fungal: Candida albicans, cryptococcal infections.
    • Bacterial: Mycobacterium tuberculosis, mycobacterial infections.
    • Viral: Cytomegalovirus, herpes simplex.
    • Protozoal: Pneumocystis carinii pneumonia, toxoplasmosis.

Antiretroviral Therapy (ART) Guidelines

  • HAART Overview:
    • Combination of 2 NRTIs with 1 NNRTI or protease inhibitor.
    • Objectives: Reduce viral load, increase CD4 counts, prevent symptoms and opportunistic infections.
  • Drug Classes:
    • NRTIs: Emtricitabine, Zidovudine, Lamivudine.
    • NNRTIs: Efavirenz, Nevirapine.
    • Protease Inhibitors: Atazanavir, Lopinavir.
    • Integrase Inhibitors: Raltegravir, Dolutegravir.
    • Fusion Inhibitors: Enfuvirtide, block HIV entry into T-cells.

Nursing Process: Care and Interventions

  • Assessment: Monitor physical and psychosocial health, potential risk factors, immune function, nutrition, skin integrity, respiratory status, and knowledge level.
  • Potential Diagnoses: Impaired skin integrity, diarrhea, activity intolerance, risk for infection, disturbed thought processes, imbalanced nutrition.
  • Interventions:
    • Skin Care: Frequent assessments, gentle soaps, avoid irritants.
    • Bowel Care: Monitor patterns, dietary adjustments to ease diarrhea.
    • Activity Management: Balance activity with rest.
    • Nutritional Support: Monitor intake, provide supplements if necessary.
    • Communication: Engage in supportive discussions addressing psychosocial needs and information on infection spread.

Patient Education and Compliance

  • Importance of Adherence: Vital for effective viral load reduction and overall health outcomes.
  • Monitoring and Follow-up: Regular medical evaluations for timely interventions and education on ART side effects.

Gerontology Considerations

  • Older Adults: >25% of HIV patients are over 50; may face delayed diagnosis due to social stigma and lack of awareness of risk.
  • Common Health Challenges: Pneumonia, wasting syndrome, cognitive decline.

Co-Infections

  • HIV and HCV: Screening recommended since HCV can worsen HIV morbidity; careful management of drug interactions during treatment is crucial.

PPE and Standard Precautions

  • When to Use PPE: Always utilize when dealing with body fluids or potential exposure to HIV.
  • CDC Guidelines: Proper donning and doffing techniques to maintain safety during care procedures.

Key Practice Questions for Review

  1. How to instruct a client on medication compliance with ART?
  2. Identify dietary modifications appropriate for a patient with a suppressed immune system due to HIV/AIDS.